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PubMed2004

Cost assessment of a school-based mental health screening and treatment program in New York City.

Although school-based mental health screening and treatment programs have been proposed as a viable means of reaching youth with unmet mental health needs, no previous reports have attempted to comprehensively document the costs of such programs. The purposes of this report are (1) to estimate the cost of a school-based mental health screening and treatment program in a real-world school setting, and (2) to outline the methods and procedures that should be employed by future investigators to explore the costs of such programs. The program, located in a middle school in a low-income, largely Hispanic neighborhood in New York City, aimed to screen all students in Grades 6-8 for anxiety, depression, and substance use disorders. Most students in need of treatment were referred to the school-based treatment program, where social workers offered individual and group counseling. Economic evaluation methods and a before/after study design were used to assess the costs of the screening and treatment programs for 3 years of operation. Costs were estimated from the societal perspective, which includes all measurable program costs regardless of who bears the costs, and the school perspective, which includes only costs that would be borne directly by a school operating these programs. Data primarily came from administrative records and staff interviews. The total cost ranged from 106,125 dollars to 172,018 dollars for the screening program and from 420,077 dollars to 468,320 dollars for the treatment program. The cost of the screening program ranged from 149 dollars to 234 dollars per student and the cost of the treatment program ranged from 90 dollars to 115 dollars per session. These costs were estimated from the perspective of society. Applying economic cost analysis methods in a real-world school setting is challenging, but the process can generate useful estimates. Cost analyses and cost-effectiveness studies are needed in this area.

Adolescent↗

PubMed2006

Factors influencing applicant ranking of orthodontic programs.

Orthodontic programs spend considerable amounts of effort to attract, recruit, and interview the best and brightest applicants. Applicants and programs submit ranked preferences, and resident positions are filled by a computerized matching system (Match). The specific aims of this study were to determine the relative importance of certain factors in applicants' Match ranking of orthodontic programs and differences between orthodontic program directors' perceptions and actual factors cited by applicants influencing their ranking of orthodontic programs. Surveys were mailed to 55 orthodontic program directors and 478 applicants participating in the 2002 orthodontic Match. Forty-nine program director (89%) and 224 applicant (47%) surveys were returned. Rankings and importance of factors cited by applicants in their decision-making process and perceptions of those factors cited by program directors were compared. Applicants' top three factors were: "satisfied current residents," "multiple techniques taught," and "good quality of clinical facility." Program directors' perceived top three factors were: satisfied current residents, "good program reputation," and "good impression of current residents at interview." Comparing program directors' perceptions vs applicants' factors overall, the two groups were statistically different (P < .0001). Factors that stood out for their differences included: "GRE required or emphasized" (P < .0002), multiple techniques taught (P < .0007), and "good location" (P < .0008). Despite these differences, there was generally a high level of overall agreement between program directors' perceptions and factors actually influencing applicants' ranking of orthodontic programs.

Adult↗

PubMed2002

Substance abuse attitudes and policies in US rehabilitation training programs: a comparison of 1985 and 2000.

OBJECTIVE: To assess and compare the attitudes, beliefs, and policies of physical medicine and rehabilitation (PM&R) training programs toward substance abuse and tobacco use over the last 15 years. DESIGN: A blinded questionnaire was sent to all US rehabilitation medicine training program directors. Results were compared with a survey conducted in 1985. SETTING: US PM&R residency training programs with inpatient rehabilitation training. PARTICIPANTS: Training directors or their designated agents. INTERVENTION: A 35-item questionnaire was mailed between November 1999 and April 2000 to the 81 US training programs identified by the American Board of Physical Medicine and Rehabilitation as having rehabilitation training programs with inpatient rehabilitation units. Responses were pooled by our Survey Research Center to preserve anonymity. Training programs that did not respond received additional mailings and telephone calls to improve the response rate. MAIN OUTCOME MEASURES: Chi-square analysis to assess changes in responses with time. RESULTS: Forty-six of the 79 (58%) eligible training programs responded (1 program had merged, 1 did not provide inpatient rehabilitation). Programs were located in cities ranging from less than 100,000 (n = 2) to greater than a million inhabitants (n = 18). Eighty percent (37/46) of the respondents were "concerned or very concerned" about their patients' alcohol and drug use, and 69% routinely assessed patients for alcohol and drug use compared with only 25% in 1985 (P <.00001). Almost all respondents (43/46) supported written guidelines to prohibit alcohol and drug use by patients in the rehabilitation unit. Eighty-three percent had a prohibition policy, and 72% had written guidelines. Both of those rates represent increases from the 1985 response rates of 65% and 45%, respectively. Ambivalence persisted about appropriate treatment programs for persons with disabilities: in 1985, 51% of the respondents agreed that a person with a disability could be treated appropriately in a substance abuse program designed for persons without a disability; in 2000, the percentage had increased to 64%. All respondents believed that tobacco use is an addiction, but only 25% of their units offered tobacco cessation services to patients on their rehabilitation unit. CONCLUSION: The survey results are encouraging. Since 1985, not only have substance abuse issues been recognized, but also systemic institutionalized approaches (eg, regular screening, written guidelines) have increased markedly. Tobacco is now uniformly accepted as an addiction, but screening and access to cessation programs are similar to that available for alcohol and drug treatment programs 15 years ago.

Alcoholism↗

PubMed2000

Two separate tracks? A national multivariate analysis of differences between public and private substance abuse treatment programs.

OBJECTIVE: This study describes differences between public and private substance abuse treatment programs. METHOD: Data from the National Drug and Alcoholism Treatment Unit Survey (NDATUS) were analyzed with regression models that evaluated the association between ownership and program characteristics. RESULTS: Programs operated by state and local government and nonprofit agencies had more staff, but federal and for-profit programs employed more psychologists and medical doctors. We found that, in most treatment settings, for-profit programs were smaller and more likely to specialize in providing treatment in a single setting. Methadone maintenance programs were larger when operated under for-profit ownership, however. For-profit programs received more funding from private insurance and client fees. CONCLUSIONS: We found substantial differences between public and private programs, but this division was not strictly dichotomous. Federal programs differed from public programs operated by state and local governments. Programs operated by nonprofit agencies had characteristics that placed them between private for-profit and public programs. State and local agencies are contracting with private managed behavioral health care organizations to provide sub stance abuse treatment and other mental health care. The characteristics of for-profit programs may represent the future direction of substance abuse treatment.

Humans↗

PubMed1998

A mobile HIV education and testing program: bringing services to hard-to-reach populations.

Few programs exist that offer a range of human immunodeficiency virus (HIV) services to multiple populations (i.e., substance abusers, individuals on probation, sex workers and their clients, court-mandated perpetrators of domestic violence) in multiple settings (i.e., courts, methadone maintenance clinics, residential and outpatient substance abuse treatment programs). The purpose of this article is to describe a model mobile HIV program, highlighting its flexibility in providing services to clients who infrequently present to traditional clinic-based testing sites. This mobile HIV program was developed to provide on-site HIV testing and counseling, education, and linkages to primary care services. The implementation of the program begins with training of agency staff, who then provide preliminary orientation with clients regarding HIV testing. Approximately 3 weeks later, the mobile program staff (HIV nurse specialist and HIV counselors) provide standardized group pretest counseling and education. Clients who decide to be tested meet with mobile program staff for individualized risk assessment and specimen collection. Two weeks later, clients meet with mobile program staff to obtain results and receive posttest counseling; risk reduction strategies are reemphasized at that time. Unique to this program is the provision of referrals for a wide range of primary care services for both seropositive and seronegative clients. Since 1994, the mobile program has been implemented at six sites, and over 1100 clients have been served. Two major outcomes from the program have been observed: 1. With adequate preparation and psychological support, 40% of hard-to-reach populations will elect to be HIV tested. 2. Through social networks of program participants, HIV-positive individuals not previously engaged in care have been referred to a comprehensive HIV primary care program.

Boston↗

PubMed2001

An analysis of gene-finding programs for Neurospora crassa.

MOTIVATION: Computational gene identification plays an important role in genome projects. The approaches used in gene identification programs are often tuned to one particular organism, and accuracy for one organism or class of organism does not necessarily translate to accurate predictions for other organisms. In this paper we evaluate five computer programs on their ability to locate coding regions and to predict gene structure in Neurospora crassa. One of these programs (FFG) was designed specifically for gene-finding in N.crassa, but the model parameters have not yet been fully 'tuned', and the program should thus be viewed as an initial prototype. The other four programs were neither designed nor tuned for N.crassa. RESULTS: We describe the data sets on which the experiments were performed, the approaches employed by the five algorithms: GenScan, HMMGene, GeneMark, Pombe and FFG, the methodology of our evaluation, and the results of the experiments. Our results show that, while none of the programs consistently performs well, overall the GenScan program has the best performance on sensitivity and Missing Exons (ME) while the HMMGene and FFG programs have good performance in locating the exons roughly. Additional work motivated by this study includes the creation of a tool for the automated evaluation of gene-finding programs, the collection of larger and more reliable data sets for N.crassa, parameterization of the model used in FFG to produce a more accurate gene-finding program for this species, and a more in-depth evaluation of the reasons that existing programs generally fail for N.crassa. AVAILABILITY: Data sets, the FFG program source code, and links to the other programs analyzed are available at http://jerry.cs.uga.edu/~wang/genefind.html. CONTACT: eileen@cs.uga.edu.

Algorithms↗

PubMed1998

Epidemiologic support to state and local sexually transmitted disease control programs. Perceived need and availability. The Field Epidemiology Network for STDs (FENS).

BACKGROUND AND OBJECTIVES: Sexually transmitted diseases (STDs) comprise the majority of national infectious disease morbidity reported, yet the number of epidemiologists working in state and local STD programs is estimated to be small. Even less is known about the training and activities of those epidemiologists. GOALS: To determine the number, training, and affiliation of epidemiologists working with STD programs and the level of satisfaction with epidemiologic support available. STUDY DESIGN: Survey of 65 program managers in state and local health departments. RESULTS: Program managers named 146 people working on epidemiologic activities, and 84 of those people were classified as "epidemiologist" by the criteria we applied. The median number of full-time equivalent (FTE) epidemiologists working in or with STD programs was 0.5; one quarter of all STD program had no epidemiologists. There was a significant association between number of FTE epidemiologist and population, with most programs with more than 0.5 epidemiologists located in areas with at least 1,000,000 population. State Epidemiologists do not provide technical support to most state STD programs. Almost half (45%) of all program managers indicated that they have inadequate epidemiologic support for routine program activities. CONCLUSIONS: The current level of epidemiologic support available to most STD programs is inadequate to perform surveillance and data analyses, interpret data to develop program objectives, and perform program evaluation. An essential next step is the delineation of a set of critical, analytic STD field epidemiology functions to define appropriate standards against which epidemiologic capacity can be more precisely measured.

Epidemiology↗

PubMed2003

Factors used by pediatric emergency medicine program directors to select their fellows.

BACKGROUND: Pediatric emergency medicine (PEM) recently has become a highly competitive subspecialty with twice the number of applicants for positions available. Little information exists on the characteristics that PEM programs desire in their applicants. We sought to assess the factors used by PEM program directors when ranking PEM fellow applicants in the National Resident Match Program (NRMP). METHODS: A 47-item questionnaire (adapted from a previously published questionnaire) was designed to assess the relative importance of various factors in the ranking of PEM fellow applicants in the NRMP. The questionnaire was mailed to all 43 PEM program directors that participated in the 2001 NRMP. The program directors were asked to grade selection factors based on a five-point Likert scale: 1, unimportant; 2, somewhat important; 3, important; 4, very important; 5, critical. The factors addressed in the questionnaire included academic criteria, letters of recommendation, applicant characteristics, and aspects of the interview. In addition, we asked 10 yes-or-no questions pertaining to specific aspects of each program. Responses were tabulated and means and standard deviations reported. RESULTS: A program response rate of 93% (40/43) was obtained. The most important factors in granting an interview were recommendations from colleagues in PEM (4.21 +/- 0.78), research potential (3.81 +/- 1.10), and reputation of the applicant's pediatric program (3.51 +/- 0.91). The least important factors in granting an interview were reputation of the applicant's undergraduate institution (1.76 +/- 0.86), medical school grades (1.83 +/- 0.87), and board scores (2.11 +/- 0.91). Letters from division chiefs of PEM (4.15 +/- 0.78) and clinical faculty in PEM (4.06 +/- 0.82) were considered the most important letters of recommendation, whereas letters from basic science faculty were considered the least important (1.89 +/- 0.96). Ability to work with a team (4.66 +/- 0.42), compatibility with the program (4.65 +/- 0.35), commitment to hard work (4.55 +/- 0.45), ability to grow in knowledge (4.41 +/- 0.58), ability to solve problems (4.36 +/- 0.63), ability to listen (4.34 +/- 0.65), and ability to articulate thoughts (4.32 +/- 0.59) were the most important characteristics in the final ranking of candidates. Thirty percent (12/40) of the program directors stated that it was important for the program to "match" its top choice. The majority of programs have a selection committee that contributes to the final ranking of applicants. CONCLUSIONS: The results of this study suggest that a rather subjective but uniform prioritization of criteria is used in evaluating PEM program applicants. Awareness of these factors would enable applicants to make a critical self-analysis of their strengths and weaknesses prior to the submission of their applications.

Clinical Competence↗

PubMed2000

Does interview date affect match list position in the emergency medicine national residency matching program match?

OBJECTIVE: Some residency applicants believe that the date on which they interview with a residency program influences how the program ranks them in the National Residency Matching Program (NRMP). Therefore, the authors studied whether interview date affects match list position in the emergency medicine (EM) residency match. METHODS: Forty-four Accreditation Council for Graduate Medical Education (ACGME)-accredited EM residency programs participated in this multicenter study. The interview date and match list position were collected for each interviewee for the 1997-98 season. Programs were also asked about factors that might potentially bias interview date assignment. Statistical analyses were performed both with and without these programs included. Interview dates and match list positions were standardized into percentile date and percentile rank for each program and were compared using linear regression analysis. Scatterplots graphed interview date vs match list position. Two-sample t-tests compared interview dates for ranked and nonranked interviewees. RESULTS: Data were collected for 3,800 individual interviews; 14% of these resulted in unranked applicants. Twenty-three programs, representing 1,997 interviews, reported potential bias in their interview date assignment. Regression analysis revealed an R(2) of 0.018268 (correlation coefficient = 0. 1352, 95% CI = 0.0992 to 0.1617) for all programs, R(2) of 0.010626 (correlation coefficient = 0.1031, 95% CI = 0.0571 to 0.1485) for programs without reported potential bias, and R(2) of 0.02444 (correlation coefficient = 0.1563, 95% CI = 0.10887 to 0.20309) for programs with reported bias. Scatterplots revealed no linear correlation. Two-sample t-tests for all programs, and programs with and without reported bias showed no significant difference in average interview date for ranked and unranked interviewees (both with p > 0.2). CONCLUSION: In this study, interview date for EM residency positions in the 1997-98 season did not affect match list position among ranked applicants. Moreover, interview date had nno effect on the decision to leave candidates unranked.

Emergency Medicine↗

PubMed1997

Probabilistic incremental program evolution

Probabilistic incremental program evolution (PIPE) is a novel technique for automatic program synthesis. We combine probability vector coding of program instructions, population-based incremental learning, and tree-coded programs like those used in some variants of genetic programming (GP). PIPE iteratively generates successive populations of functional programs according to an adaptive probability distribution over all possible programs. Each iteration, it uses the best program to refine the distribution. Thus, it stochastically generates better and better programs. Since distribution refinements depend only on the best program of the current population, PIPE can evaluate program populations efficiently when the goal is to discover a program with minimal runtime. We compare PIPE to GP on a function regression problem and the 6-bit parity problem. We also use PIPE to solve tasks in partially observable mazes, where the best programs have minimal runtime.

Journal Article↗

PubMedDate not supplied

Administrative restructuring of a residency training program for improved efficiency and output.

OBJECTIVES: Canadian residency training programs (RTP) have a program director (PD) and a residency program committee (RPC) overseeing program administration. Limited guidance is available about the ideal administrative structure of an RTP. This article describes administrative load in Canadian RTPs, presents a novel approach to delegating core administrative tasks within the RTP, and provides initial impressions of positive outcomes following implementation of this new system. METHOD: All PDs of Canadian psychiatry RTPs were surveyed with respect to their program administrative structure, involvement of their training committees, and the percentage of work done by the PD compared to the rest of the RPC. At Queen's University, program domains were created representing well-defined areas within the RTP, each being assigned a program domain manager. RESULTS: RPCs were mainly consultative, averaging 14 members. The average PD: RPC workload ratio was 80:20. Three programs allowed for 50% of the program director's time to be dedicated to serving that position, with an average time dedication of 37%. CONCLUSION: The position of PD in psychiatry requires an average of 37% of the program director's time, while carrying an estimated 82% of the administrative workload. The program domain manager administration system implemented at Queen's University enabled the PD to be simultaneously up to date with all major areas of the program while experiencing a substantial decrease in the administrative workload, achieved through increased work contribution of the RPC. This system encourages closer involvement of RPC members in decision making and development of their program domains, allowing the PD more time for developing, implementing and overseeing innovations across the RTP spectrum. Furthermore, it has led to a PD: RPC workload shift from a ratio of 90:10 to one of about 60:40. Essentially, this resulted in a more efficient and adaptable RPC and RTP.

Canada↗

PubMed1983

Study of the rehabilitation, prognosis and capacity to resume work of patients with myocardial infarction--comparison of 4-week and 8-week rehabilitation programs.

The relative benefits of 4- and 8-week rehabilitation programs were compared in inpatients with myocardial infarction. In the 8-week program, complete bed rest was instituted for the initial 3 days, followed by walking around the bed from the 14th day; exercise was gradually increased to target levels such as walking for distances of 500m per time up to a total of 2 to 3 km and climbing up and down several sets of 20 stairs daily. In the 4-week program, complete bed rest was provided for the initial 3 days, and exercise was more rapidly increased for 4 weeks to reach the same exercise level as that of the 8-week program. The duration of hospitalization, and the clinical progress, prognosis and the ability to return to work after discharge of the patients were compared in each program. The percentage of patients who were hospitalized for 40 days or less increased from 0% in the 8-week program to 15.9% in the 4-week program, while the percentage of patients who were hospitalized from 41 to 60 days increased from 13.3 to 37.0%. Shortening of the program did not cause significant differences in the incidence of serious complications such as heart failure, arrhythmia and infarction. The 2-year mortality was 15.9% in the 8-week program and 7.9% in the 4-week program. The state of work after discharge was comparable in both programs. Exercise tolerance, measured by bicycle ergometer, tended to improve remarkably 6 months after infarction. Based on the above results, the 4-week program is considered to be more practical than the 8-week program.

Bed Rest↗

PubMed2003

Examination of the communication practices between state newborn screening programs and the medical home.

BACKGROUND: As outlined in the Newborn Screening Task Force report published in August 2000, the newborn screening system is more than just testing, but also involves follow-up, diagnosis, treatment, and evaluation. As such, multiple professional and public partners need to be adequately involved in the system to help ensure success. In addition, newborn screening programs are state-based; therefore, policies and procedures vary from state to state. Historically, there has been little uniformity between state newborn screening programs. OBJECTIVE: To examine the communication practices of state newborn screening programs in the United States, particularly in relation to the medical home. METHODS: A facsimile survey of program staff in all US newborn screening programs. Survey data were collected in August 2000. RESULTS: All 51 programs participated. States were questioned about whether or not they had a procedure to identify the infant's medical home before the child's birth. Twelve states (24%) indicated that there was a procedure in place, whereas 39 states (76%) indicated that either no procedure existed or that they were unsure. In contrast, all state programs (except 1) indicated they notified the primary care physician about abnormal results and the need for follow-up. In addition, state programs reported that primary care physicians have responsibilities within the newborn screening system, particularly related to communicating with parents about screen-positive results and coordinating the collection of a second specimen. Thirty states reported that they directly notified parents of screen-positive infants of results and the need for follow-up as well. In regard to informing parents about newborn screening, 45% of states indicated that primary care physicians had some responsibility in informing parents about newborn screening. Most often, parents were informed about newborn screening just before specimen collection, and the most commonly used techniques to educate parents were informational brochures and conversation. Thirty-five states reported that they engaged in long-term tracking of infants after diagnosis confirmation. Only about half of these states provided long-term tracking of all of the conditions included in their state's newborn screening test panel. Of these 35 states that engaged in long-term tracking, 25 reported that they requested patient information from the primary care physician and/or subspecialist about ongoing treatment and follow-up. CONCLUSIONS: Newborn screening roles and responsibilities vary tremendously between states. Improvements in communication and better-defined protocols are needed, particularly between state newborn screening programs and the medical home. Many states identified the medical home as having significant responsibilities related to the short-term follow-up of screen-positive infants. Identification of the correct medical home before testing would help to reduce unnecessary time and frustration for state newborn screening programs, especially in the follow-up of infants that are difficult to locate. In addition, primary care physicians (ie, the medical home) need to have appropriate and ongoing involvement, including a mechanism to provide feedback to their state newborn screening program. This is particularly important given the adoption of tandem mass spectrometry by an increasing number of states, and the likely expansion of newborn screening in the future. Recommendations include the following: Primary care physicians should have appropriate and ongoing involvement in the newborn screening system and should be appropriately represented on state newborn screening advisory committees. States should develop protocols to identify the medical home before heelstick screening. States should work with families, primary care physicians, and prenatal health care professionals to develop well-defined systems for pretesting education of parents. All newborn screening results (both positive and negative) should be sent to the infant's medical home. If results are not received by the medical home, efforts should be made to obtain results. Medical homes and subspecialists should submit follow-up information on screen-positive infants and infants with confirmed diagnoses to the state newborn screening program, regardless of the existence of state requirements to do so, and efforts to build enhanced direct communication systems, linking state newborn screening programs to community-based medical homes, should continue.

Communication↗

PubMed2005

Online health behavior and disease management programs: are we ready for them? Are they ready for us?

Advancing the science and practice of health promotion and disease management on the Internet requires a systematic program of research examining the population impact of such programs. With impact described as the combination of effectiveness and participation, such research needs to include the examination of the quality and effectiveness of programs that are available to the general public, as well as descriptive and predictive knowledge about population readiness to participate in such programs. There have been few studies examining the quality of interactive health behavior change (HBC) programs on the Internet, and even fewer investigations of the effectiveness of such programs. Based on the review of over 300 HBC programs on the Internet using the "5 A's" of Health Behavior Change on the Internet (HBC-I Screener), which represent standard minimum guidelines for evaluation, it appears HBC on the Internet is in the early stages of development. As health behavior change on the Internet matures from the provision of health information to meeting the requirements necessary to produce health behavior change, and as program developers take advantage of the interactive nature of the Internet, the basic screening and expanded evaluation criteria developed in this project will provide templates for both consumers and developers of programs. The second component necessary for evaluating the impact of HBC on the Internet is the extent to which the population is ready to participate in such programs. We need to move beyond a narrow focus on early adopters and produce a population perspective that includes those not ready, those getting ready, and those ready to use such programs, as well as those already participating. By understanding participation levels of such programs, and what drives this participation, the development and dissemination of practical tailored and targeted interventions can help maximize population participation in Internet programs for health behavior change.

Attitude to Health↗

PubMed2002

Does diabetes disease management save money and improve outcomes? A report of simultaneous short-term savings and quality improvement associated with a health maintenance organization-sponsored disease management program among patients fulfilling health employer data and information set criteria.

OBJECTIVE: Little is known about the impact of disease management programs on medical costs for patients with diabetes. This study compared health care costs for patients who fulfilled health employer data and information set (HEDIS) criteria for diabetes and were in a health maintenance organization (HMO)-sponsored disease management program with costs for those not in disease management. RESEARCH DESIGN AND METHODS: We retrospectively examined paid health care claims and other measures of health care use over 2 years among 6,799 continuously enrolled Geisinger Health Plan patients who fulfilled HEDIS criteria for diabetes. Two groups were compared: those who were enrolled in an opt-in disease management program and those who were not enrolled. We also compared HEDIS data on HbA(1c) testing, percent not in control, lipid testing, diabetic eye screening, and kidney disease screening. All HEDIS measures were based on a hybrid method of claims and chart audits, except for percent not in control, which was based on chart audits only. RESULTS: Of 6,799 patients fulfilling HEDIS criteria for the diagnosis of diabetes, 3,118 (45.9%) patients were enrolled in a disease management program (program), and 3,681 (54.1%) were not enrolled (nonprogram). Both groups had similar male-to-female ratios, and the program patients were 1.4 years younger than the nonprogram patients. Per member per month paid claims averaged 394.62 dollars for program patients compared with 502.48 dollars for nonprogram patients (P < 0.05). This difference was accompanied by lower inpatient health care use in program patients (mean of 0.12 admissions per patient per year and 0.56 inpatient days per patient per year) than in nonprogram patients (0.16 and 0.98, P < 0.05 for both measures). Program patients experienced fewer emergency room visits (0.49 per member per year) than nonprogram patients (0.56) but had a higher number of primary care visits (8.36 vs. 7.78, P < 0.05 for both measures). Except for emergency room visits, these differences remained statistically significant after controlling for age, sex, HMO enrollment duration, presence of a pharmacy benefit, and insurance type. Program patients also achieved higher HEDIS scores for HbA(1c) testing as well as for lipid, eye, and kidney screenings (96.6, 91.1, 79.1, and 68.5% among program patients versus 83.8, 77.6, 64.9, and 39.3% among nonprogram patients, P < 0.05 for all measures). Among 1,074 patients with HbA(1c) levels measured in a HEDIS chart audit, 35 of 526 (6.7%) program patients had a level >9.5%, as compared with 79 of 548 (14.4%) nonprogram patients. CONCLUSIONS: In this HMO, an opt-in disease management program appeared to be associated with a significant reduction in health care costs and other measures of health care use. There was also a simultaneous improvement in HEDIS measures of quality care. These data suggest that disease management may result in savings for sponsored managed care organizations and that improvements in HEDIS measures are not necessarily associated with increased medical costs.

Aged↗

PubMed2003

Eat Smart! Ontario's Healthy Restaurant Program: a survey of participating restaurant operators.

Eat Smart! Ontario's Healthy Restaurant Program is a standard provincial health promotion program. Public health units grant an award of excellence to restaurants that meet designated standards in nutrition, food safety, and non-smoking seating. The purpose of this study was to assess whether program objectives for participating restaurant operators were achieved during the first year of program implementation, and to obtain operators' recommendations for improving the program. Dillman's tailored design method was used to design a mail survey and implement it among participating operators (n = 434). The design method, which consisted of four mail-outs, yielded a 74% response rate. Fifty percent of respondents operated family-style or quick-service restaurants, and 82% of respondents learned about the program from public health inspectors. Almost all respondents (98%) participated in the program mainly to have their establishments known as clean and healthy restaurants, 65% received and used either point-of-purchase table stands or postcards to promote the program, and 98% planned to continue participating. The respondents' suggestions for improving the program were related to the award ceremony and program materials, media promotion, communication, education, and program standards. Program staff can use the findings to enhance the program.

Consumer Behavior↗

PubMed2005

A comparison of three animal welfare assessment programs on California dairies.

Due to increased awareness of animal welfare issues by consumers, 3 voluntary programs were developed to assess animal welfare on commercial dairies in the United States. These programs include: 1) Humane Farm Animal Care (HFAC), with minimum standards and a third-party audit system; 2) Dairy Quality Assurance Center (DQAC); and 3) University of California-Davis (UCD) program with self-assessments. The objective of this article was to provide an overview of the similarities and differences in content and scope of these programs. Furthermore, to ascertain the practical application of these programs on commercial dairies, a study was designed to compare the rank order of compliance scores of each program on 10 commercial California dairies using a survey and personal interviews with dairy owners or managers. The survey combined 316 statements from the DQAC checklist, the UCD assessment, and the HFAC standards. The mean (+/-SD) percentage compliance for the DQAC, HFAC, and UCD programs was 83 +/- 8, 94 +/- 3, and 85 +/- 6%, respectively. A ranking order from 1 to 10 was assigned to each dairy using the compliance score for each assessment program. Comparisons of ranking order between programs were not significant, indicating that different indices were being measured by each program. All programs, however, identified the same 2 lowest-ranking dairies, which indicated that the programs were able to identify facilities with the weakest welfare practices. The survey results show that selection of the available assessment programs for animal welfare on the dairy is important in determining the outcomes.

Animal Welfare↗

PubMed2000

Vaccination coverage among children enrolled in Head Start programs or day care facilities or entering school.

PROBLEM/CONDITION: Undervaccinated children enrolled in day care centers and schools are vulnerable to outbreaks of vaccine-preventable diseases. A Healthy People 2000 objective is to increase to > or = 95% vaccination coverage among children attending licensed day care facilities and kindergarten through postsecondary school (objective 20.11). REPORTING PERIOD COVERED: September 1997-June 1998. DESCRIPTION OF SYSTEM: CDC's National Immunization Program administers grants to support 64 vaccination programs. These programs are in all 50 states, eight territories or jurisdictions (American Samoa, Republic of Marshall Islands, Federated States of Micronesia, Guam, Commonwealth of Northern Mariana Islands, Puerto Rico, Republic of Palau, and the U.S. Virgin Islands), five cities (Chicago, Houston, San Antonio, New York City, and Philadelphia), and the District of Columbia. Grant guidelines require annual school vaccination surveys and biennial surveys of Head Start programs and licensed day care facilities. This system constitutes the only source of nationally representative vaccination coverage estimates for these populations. RESULTS: Head Start Programs: Of the 64 reporting areas, 33 (51.6%) submitted coverage levels for children enrolled in Head Start programs. Of these, all 33 programs reported coverage levels for diphtheria and tetanus toxoids and pertussis vaccine (DTP), diphtheria and tetanus toxoids (DT), or tetanus toxoids (Td), poliovirus vaccine, and measles vaccine; and 32 reported coverage levels for mumps and rubella vaccines. Four programs reported coverage levels for the combined measles, mumps, and rubella vaccine (MMR). The mean vaccination coverage levels for the 1997-98 school year among the reporting vaccination programs were 97.8% for poliovirus vaccine (range: 80.0%-100.0%), 97.0% for DTP/DT/Td (range: 87.7%-100.0%), 93.3% for measles vaccine (range: 91.4%-100.0%), and 93.2% for mumps and rubella vaccines (range: 91.4%-100.0%). Licensed Day Care Facilities: Of the 63 reporting areas with licensed day care facilities, 38 (60.3%) submitted coverage levels for enrolled children. Of these, all 38 programs reported coverage levels for poliovirus vaccine and DTP/DT/Td, 37 reported coverage levels for measles vaccine, and 36 reported coverage levels for mumps and rubella vaccines. Four programs reported coverage levels for the combined MMR. The mean vaccination coverage levels among the reporting areas were 95.8% for poliovirus vaccine (range: 85.1%-99.8%), 95.7% for DTP/DT/Td (range: 77.6%-99.9%), 89.1% for measles vaccine (range: 78.0%-99.9%), and 89.1% for mumps and rubella vaccines (range: 78.0%-99.9%). Kindergarten/First Grade: Of the 64 reporting areas, 43 (67.2%) submitted coverage levels for children enrolled in kindergarten and first grade. Of these 43 programs, 42 reported coverage levels for poliovirus vaccine and DTP/DT/Td, and 43 reported coverage levels for measles, mumps, and rubella vaccines. Four of the 43 programs reported coverage levels for the combined MMR. The mean vaccination coverage levels among the reporting areas were 96.7% for poliovirus vaccine (range: 82.8%-99.9%), 96.7% for DTP/DT/Td (range: 82.8%-99.8%), 96.0% for measles vaccine (range: 82.8%-99.9%), and 96.5% for mumps and rubella vaccines (range: 82.8%-99.9%). INTERPRETATION: High levels of vaccination coverage among children entering school most likely result from the successful implementation of state-specific school vaccination laws, which have applied to children entering school in all states and the District of Columbia since at least 1990. All states, territories, and the District of Columbia have additional laws that require vaccination of children in licensed day care facilities. However, because a high proportion of states and territories did not submit vaccination coverage reports to CDC, these estimated means may not reflect levels for all children in the United States.

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